Provider Demographics
NPI:1174694210
Name:LIU, CHING CHENG (DDS)
Entity type:Individual
Prefix:
First Name:CHING CHENG
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3671 N MALL ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1706
Mailing Address - Country:US
Mailing Address - Phone:949-231-9547
Mailing Address - Fax:
Practice Address - Street 1:19103 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7104
Practice Address - Country:US
Practice Address - Phone:562-402-1918
Practice Address - Fax:562-924-7669
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice